However issues of woundedness, weakness, limitation, difference and vulnerability Working with the transference/countertransference relationship and with the ruptures The developmentally-needed or reparative relationship is defined by. Therapist–client psychological contact: a relationship between client and in 'the presenting past 'also known as 'transference' the idea that the client reminds us of “The developmentally needed or reparative relationship is an intentional. Clarkson states that there are five types of relationships potentially present in These are (a) the working alliance, (b) the transference/countertransference relationship, (c) the developmentally needed/reparative relationship, (d) the . In reading the cases, therapists can identify similarities with their own.
A variety of responses to these feelings may occur. Disability may be denied, losing connection with what is real. There may be avoidance, distancing or rejection. Alternatively there may be an attempt to provide perfect care to make up for the weakness and pain. We may fall into judging ourselves to be inferior or superior, bringing feelings of worthlessness or contempt. Or we may put unwanted parts of ourselves into those who are different leading to denigration, contempt, rejection, abuse and exclusion.
These feelings and responses will tend to undermine or destroy the therapeutic relationship or may even lead to a reluctance to offer therapy at all. This is of particular value in work with people with learning disability who may have difficulty in recognising, naming and expressing their feelings. For example in this work I often felt confused and overwhelmed which I understood as an indication of what the patient might have been feeling.
Another time my strong feeling of being rejected and contemptible proved to be an invaluable aid in understanding what the patient was feeling. Both are examples of identifying countertransference.
CAT understands transference and countertransference in terms of Reciprocal Roles RR being played out within the therapy. In one case I found myself being uncharacteristically neglectful over an agreed arrangement.
In the special interest group we recognised that polarised responses often occur in people with learning disability.Petruska Clarkson - 5 relationship model explained !
Kim, when choosing a button to represent herself, selected a very small button because she felt that she could not do anything, whilst she chose a very large button for me. It was as if in facing the cognitive difference between us she felt completely worthless and useless. It was good to see that when she repeated the exercise towards the end of therapy she chose buttons of much more equal size. Ideal care is often sought out and reciprocated. It is as if we need to somehow magically make up for the limitation, vulnerability and sense of woundedness, which are faced by patients on a daily basis.
CAT helped me to be aware of this and to avoid colluding with it. She also suggests three types of injury or deficit, which may require a reparative relationship, all of which are highly relevant to the lives of people with learning disability. They are trauma, such as abuse ; strain or accumulative, repeated less severe traumas such as are associated with neglect and deprivation and the negative attitudes of society ; and extra-familial limitations and catastrophes in which she includes genetic conditions.
Missing elements, which may be provided in the reparative relationship are identified by Clarkson p as containment, witness and care.
KEY PSYCHOTHERAPEUTIC THEORIES | Crowe Associates
Casement suggests that where there has been neglect, careful attention and responsiveness are needed; where there has been smothering, respect and space are required.
In addition the structure of CAT could be understood as providing a reparative, holding environment for both patient and therapist. I found this aspect of the therapeutic relationship to be particularly important in work with people with learning disability. What was needed varied from patient to patient and also with different stages in therapy with the same patient. Early on in therapy I was often aware that I took a very explicit encouraging, accepting and nurturing role, taking responsibility for keeping harmony between us and allowing a degree of dependency.
Reassurance was often a strong need at this point. I allowed Barbara to hold my hand when she talked about the time when she had been swamped by feelings of anger and hopelessness when she was first told as a child that she had a learning disability and that nothing could be done to help her.
As well as reassurance she needed responsiveness from me to allow her to re-live that terrible moment in a different emotional climate. She needed patient encouragement and support whilst she found her own strength.
As therapy progressed it was important to give her more space to try out her new-found strength and to become more emotionally independent. Clarkson ; McCormick It is suggested in the literature that the person-to-person relationship involves a certain amount of self-disclosure by the therapist. Gelso and Carter ; McCormick ; Thorne Care and skill are needed to judge the timing and degree of self-disclosure and it must always be undertaken in the service of the therapy and not for the therapist.
Perhaps what people with learning disability most long for and need is the experience of the person-to-person relationship in which two adults meet as equals. Much can get in the way of this, but my experience was that when we were truly able to make authentic connection as human beings of equal value, then change, growth and transformation could occur.
I found that this aspect of therapy tended to grow as the therapy progressed and that it could be encouraged by limited self-disclosure which allowed the patient to have a sense of the person behind the therapist. In my practice this was initially extremely limited, for example to a personal comment about a shared experience such as the weather or noise outside the room.
I found that too early or too much self-disclosure was either ignored or caused tension within the relationship. However appropriate self-disclosure could be transforming. Michael saw himself and others as being either all good, loved and accepted or all bad, blamed and rejected.
Then we were able to share the reality that, as human beings, we both made mistakes and when we did, if we recognised them and tried to make amends for any hurt we had caused, then it was not the end of the relationship, rather it allowed a deepening and strengthening of the bond between us. This marked a turning point in the therapy and also in his relationships outside.
Another example was when I arrived very late for one of my sessions with Claire. As well as accepting my apology she was able to say that she felt angry with me.
I was no longer the idealised, nurturing mother.
I became another human being who sometimes got it wrong. This allowed us to move forwards with that experience of equality and humanity woven into our work. In work with people with learning disability the person-to-person relationship necessarily includes the difference in intellectual capacity. I found that in most CAT therapies with people with learning disability there came a point when this difference needed to be openly acknowledged by us both.
For this to be able to happen it seemed necessary for the patient to develop confidence in herself, the therapist and the therapeutic relationship and to be able to say directly that she was having difficulty in understanding the work. This was often preceded by a sense of stuckness. Bringing the difficulty out in the open allowed us to see how the difference was a problem for us both. At this point we moved from the developmentally-needed relationship to the person-to-person relationship. We could begin to accept the difference between us and understand that it was our joint responsibility to find a way of expressing the work, which held meaning for us both.
In this way we were acknowledging the difference, but valuing and respecting each other as human beings of equal value. When this happened it marked a turning point in the therapy, allowing the work to flow again and bringing a new creativity.
CAT, the Therapeutic Relationship and Working with People with Learning Disability
We could see how this was an enactment of one of her Target Problem Procedures. I was then able to say that I felt that this made a problem for us both and that I had a responsibility to be clearer and that I needed her to tell me when I was not being clear enough. This opened up the therapy. With Michael we used buttons in each session to help him express his feelings and experience. It is necessary to remember that this sort of relationship has a seductive potential.
However by encouraging the development of the real relationship CAT could be understood as opening up the possibility of the transpersonal. Clarkson ; McCormick p46 In my work with people who have learning disability I found that in recognising, facing, accepting and appropriately communicating our limitations, woundedness and vulnerability, in person-to-person relationship, we were brought to a part of ourselves where we could meet together, as adults of equal value, at a deeply significant level and experience a creativity which was bigger and beyond ourselves.
With it there came a sense of freeing bonds that had tied us both, allowing for spontaneity, movement and change. Often this was expressed in the diagrammatic representation of the work as the patient brought this alive with their use of colour and drawings. For examples see King I understand this to be the transpersonal aspect of relationship.
Development of the Therapeutic Relationship In all the complete CAT therapies which I undertook with people with learning disability there was an issue around the patient not making themselves heard, e. This seemed to be powerfully therapeutic. At the beginning of therapy she selected a large brown button for herself as a reflection of her sad mood. Rogers describes the core conditions of empathy, congruence and unconditional positive regard, as the foundations of building an interpersonal alliance between two people.
The person-to-person relationship is the core or real emotional connection — as opposed to a professional relationship with say your doctor or dentist. Research by Affleck has shown that it is significant to the client that there be a real relationship from within which environment the therapists can use whatever modality of therapy she or he is trained in.
Perhaps one way of describing it is the feeling you have after going to a concert you enjoyed or a really special evening with friends.
Key psychotherapeutic theries
Whilst I am careful in my Coaching practice about maintaining boundaries between coaching principles and deeper therapeutic approaches and in some cases referring clients on where we both feel it appropriate, the emerging interest in therapy over the last few years has taken me in working with clients into a more psychological way using approaches like the autobiography exercise, which encourages clients to reflect on how they have become the people they are before starting to look at how the future might unfold.
Asking someone starting work in Coaching to take you through their background is an important part of an initial session. It establishes rapport and interest in the whole person, not just the work person. This approach has certainly helped me understand in one of my clients some of the script messages from formative years that have been internalised, along with working on re-framing these messages.
Murphy and Gilbert 5 stages My sense of the two perspectives of Rogers and Clarkson is that they are useful underlying principles to the work of therapy, focusing on the interpersonal aspects of the relationship between the therapist and client.
Another interesting approach is that of Katherine Murphy and Maria Gilbert, describing some of their underlying principles, whilst alongside the principles setting out a 5 stage model of therapy Murphy and Gilbert One of their underlying aspects of people being relationship seeking and the idea of people having internalised relationship patterns is an interesting one.
They bring into play the theories of Stern in child development in how a child creates a sense of repeated similar experiences with primary carers and how this builds a set of self beliefs and behaviours built on this; what they call the core interpersonal scheme.
They do point out clearly that whilst it is stated sequentially, that these stages often are re-cycled and overlap. In my experience in other work around behaviour change such as the transtheoretical model, this is true of robust, flexible models; they contain a sense of start, middle and end, but have circumnavigated ways through. Murphy and Gilbert set out various stages that move through: The interplay of explicit and implicit communication processes Thinking about verbal and non verbal communication takes me back to my first year at University in a Psychology Module examining the work of Michael Argyle initially in the s.
I know from my own work in adult learning the power of non verbal communication in being able to intuit what is happening with clientsand indeed working with groups of people.